by Ben Bruce
Working with people who have depression on a daily basis I have learned a great deal about it's gross and subtle nuances; its origins, its aetiological development, apparent and non-apparent/ masking symptomatology; there is a whole raft of underlying contributing factors. Depression is not what it always seems to be and its causes and processes vary for different people. It is not a 'one size fits all' disorder. In deed, sometimes a person will think they have depression, and they actually do not. Essentially, they may have something like fatigue as a result of an underlying problem, like sleep apnoea or lead poisoning for example. So underlying factors need to be assessed to ascertain the 'nexus of depression'. We need to work in an integral and multi-disciplinary way to tackle something like depression. These factors include psycho-somatic connections (mind body interface), psycho-neuro-immunology (looking at the connection and feedback between the mind and psychology, the nervous system, the endocrine/hormonal and immune system). Other factors include a person's family of origin experiences, lots of patterns get set up here and there is often unresolved issues and trauma. Pychosocial political dynamics (examining levels of power and its abuse) need to be looked at, as well as existential (life meaning), biological/toxicological, historical, mindful (sense of awareness and grounded presence), tacit (know-how), meta-cognitive (self awareness of mental processes)....As you can see the list is long and dynamic. Please beware of 'used car salesmen' who say "the solution is x" in a one-stop-shop treatment style. We are complex beings so our treatment and solutions are often complex. With clinical depression, the inner workings of this 'black dog' (as Winston Churchill coined the term to describe his own depression) are often overlooked as the immediacy of the acute presentation of depression acts as a ruse belying the deeper causes and maintenance factors. It has always been my philosophy that to treat something we must continuously observe it and study its machinations, consistently questioning our assumptions in case we overlook something useful.
Stress is the biggest cause of depression. This is due to inner and outer factors. Inner factors include cognitive distortions (problematic thought patterns) and having a fierce inner critic and self-ignorance and self-abandonment (being 'beside yourself'). People can lose perspective and get caught up in dramas, sometimes at the fault of others and other times of their own making. Avoidance (of one's own experiences and not facing your fears), rumination and emotional reactivity are other factors. External factors include things like abusive relationships, lack luster communication and interpersonal skills, bullying and harassment at work, and trauma. Stress is defined as excessive demands with limited resources (money, time, energy, capacity) to meet them. If this goes on, especially if we add maladaptive (inappropriate/ unhelpful) coping strategies to the stress (like excessive drinking, drugging or obsessing) then we will eventually break down. We will lose a sense of balance. We will neglect rest and will stop investing and 'recreating' ourselves with pleasure, fun and meaningful activity. We stop acting, belonging and committing. Our nervous system will fray as we will be living on adrenalin to get through it all. Because of this our adrenal glands and endocrine/ neurotransmitter system in general will become excessive and uncalibrated (fatigued and out of whack). We will become lethargic and tired and thus get less out of life. With excessive stress our 'non-vital' functions partially shut down, like our intestinal digestion which will fail to take proper nutrients from food as energy and blood flow is rather directed to 'survival' parts of the body. We experience relative malnourishment. Sickness and disease become more likely. We age. Things get on top of us. The stress becomes heightened and tips into anxiety and perhaps panic attacks: generalized and acute moments of extreme distress.
This exhaustion eventually turns into depression.
Thus, thereby, we see the connection between stress, anxiety and depression. Other factors are also involved, like trauma, unresolved grief, adjustment to major changes, nutritional or environmental factors, relationship abuse, loneliness and isolation, family of origin dynamics such as enmeshment and closed family systems, and existential issues, like being unable to find meaning in life and missing the point of things entirely. So either way we start to avoid, shut down, withdraw....and then nothing can save us really, as nothing can get to us. We have created a thick wall, and our shield which we thought would protect us has now imprisoned us and locked down the depression. This may be reflected in an angry, obnoxious, cynical, recalcitrant, disagreeable attitude. Thereby, other people may avoid us because we are unpleasant to associate with, which only seems to confirm our initial impression that we are worthless (a cognitive distortion, a twist of meaning, that has become a self-fulfilling prophecy).
As we are inter-connected and 'intra-connected' beings (external and internal) our brains are affected by what we do, think, feel and say, whether we like it or not. This is the same as how our muscles are affected by how we use them. They can get weak and flabby with dis-use and also injured with over-use, or they can be firm and strong with correct use. Similarly our brains change over time. With the depressed mind-set (and behaviour set) the brain will become depressed as well. Neuro-transmission will decline in a 'use it or lose it way'. So if you spend less of your time being joyful and rested, the brain will make it more difficult to be joyful and rested. This is because the brain is an efficiency transmission machine. It transmits coordination of signals and also creates patterns in order to be as efficient as possible. Neuro-circuitry is the physical manifestation of this, so accordingly well heeled tracks (like those in a depressive mindset) will create a neuro-network that bolsters itself. This is why it feels like we can't get out of the rut. This is also why certain herbal tonics and medications are necessary for some people, such as the use of anti-depressants and antiumetics. Certain devices like 'Holo-synch' sound and 'Alpha-stim' micro-current brain wave affecting technology are really useful for resetting the baseline, or at least giving an interruption to the depression mindset pattern. We can experience relief with such medications and devices and consequently a window can open to let in fresh air, we can breathe again, see with greater perspective and not feel so trapped. However, these devices are rather pointless on their own. We need to get to the bottom of the pattern and change underlying depression maintenance factors. The mindset needs to be adjusted. Other changes like nutrition, sleeping pills for greater rest, and cardiovascular exercise (for cleansing, flushing of toxins and endorphin release) are also needed.
These and other such hall-mark indicators and moderating factors of depression can be dealt with by a decent psychologist. To be most effective, in most cases the holistic nature of the person must be taken into account: an integral method compiling use of multiple approaches, theories and methods must be utilized to suit the individual. In order to do so the psychologist must first 'connect' with the patient and find their 'special language' and 'sacred yielding' to emerge within their own vision quest: the ability to see the wood for the trees and make their own meaning in life.
No small task. But necessary if we wish to help. Some people require less intensive, creative and integral approaches - they might just need a supportive chat with someone who listens to them, validates their concerns and their feelings, re-frames any cynical negative bias, reassures them and tells them they are not crazy, just human. This becomes a validation and normalization as well as a re-contextualization. And it all happens inside the chat, probably without the patient even noticing it.
Sometimes the psychologist's own issues can get in the way of the therapeutic process, because we ourselves are human: the degree to which we take responsibility and get supervision for this is all that matters. Take responsibility for it, deal with it if it comes up, move on.
Intelligent people are at risk of depression just as much as naive and less sophisticated people are.
The use of logic can make a person rigid where alternative/lateral ideas and work-arounds are dismissed before being adequately explored. Sometimes intellectual hubris, pride and arrogance will be the downfall of an otherwise intelligent person; their own intelligence works against them. Logic is the application of the word 'no' and the door can be shut to anything alternative as it appears 'crazy'.
This entrapment by 'pseudo-logic' is worse in excessively left-hemisphere dominant individuals (part of the brain most relevant in language and logic). Cross-lateralization exercises can facilitate a more integrated brain and mindset, i.e. using both sides of the body, and not just favouring one hand all the time. The right hemisphere relates more to creativity and intuition; being able to see the wood for the trees and read 'between the lines'. Clearly we need all the above to tackle something like depression. We need 'mind sight' (as per Dan Siegel's term) that intra-personal insight and meta-cognition (overview of mental processes) to be able to observe how we are thinking; in so doing we can challenge it or step back from toxic patterns and cycles. We learn to reassure ourselves and relate to ourselves and others differently. As a result we can have greater understanding and flexibility, greater richness of connection (connecting the dots to make a more meaningful gestalt, or whole picture). We can use all our senses and have greater awareness and compassion for ourselves and for others. Clearly, in this way we are more likely to heal.
We need to question authority and embrace vulnerability, go to the edge, swim to the side and thrive in that 'liminal space' in order to progress to the greatest potential we can be. There is a comfort zone in depression: we may wallow in self-indulgent despair because it is familiar and does not threaten the status quo. This needs to be given up to move on, and thus in order to heal a person must allow themselves to be vulnerable. The authority that is questioned is also that which is termed 'discretion' within their own mind; that internal voice of commentary that accompanies ones thoughts wherever they go, often judgmental and dismissing of achievements and efforts and arguing for the cynical status quo. Self-imposed comfort zones may seem comfortable, but they are actually perpetuating suffering. The comfort zone epitomizes rigidity and blocks the path to progress and healing.
Therapy involves a review of maladaptive mechanisms over time; the maintenance factors of the depression mindset are scrutinized, explored and understood as well as challenged, disputed and replaced where possible. We learn to change the things we can and accept the things we cannot - therein lies the wisdom and serenity. We scrutinize thought patterns, beliefs, unresolved issues, relationship skills, fear and courage, etc.
As we are all pattern-based entities this review creates an opening for a renascence of self to emerge; a new identity and skill-set pattern to invest in and act from, a new perspective to view from. We see a different world thereby. As our minds are connected to our hearts and to our bodies and by extension to our relationships, our world and everything we do: malaise, disease, conflict and destruction all start to heal. Things get easier, better, more exciting. Like a domino effect, we start to spiral upwards and outwards. This is reinforced with reduced suffering, and even more: the more consistent and lasting occurrence of happiness, fun and joy. Difficult experiences, which will always comes and go, are put into perspective. The person becomes more resilient. We learn and grow. Our wisdom expands and deepens which also reinforces the therapeutic process: something positive has indeed come out of the suffering after all. Depression has become the fertilizer, the food of growth.